Mid-upper arm circumference only protocol in Pakistan: missed opportunities for children suffering from severe acute malnutrition? A mixed-methods observational study.

OBJECTIVE: We investigated the missed treatment opportunities affecting programmes using mid-upper arm circumference (MUAC) as the sole anthropometric criterion for identification and monitoring of children suffering from severe acute malnutrition (SAM). DESIGN: Alongside MUAC, we assessed weight-for-height Z-score (WHZ) in children screened and treated according to the national MUAC only protocol in Pakistan. Besides, we collected parents' perceptions regarding the treatment received by their children through qualitative interviews. SETTING: Data were collected from October to December 2021 in Tando Allah Yar District, Sindh. SUBJECTS: All children screened in the health facilities (n 8818) and all those discharged as recovered (n 686), throughout the district, contributed to the study. All children screened in the community in the catchment areas of five selected health facilities also contributed (n 8459). Parents of forty-one children randomly selected from these same facilities participated in the interviews. RESULTS: Overall, 80·3 % of the SAM cases identified during community screening and 64·1 % of those identified in the health facilities presented a 'WHZ-only' diagnosis. These figures reached 93·9 % and 84·5 %, respectively, in children aged over 24 months. Among children treated for SAM and discharged as recovered, 25·3 % were still severely wasted according to WHZ. While parents positively appraised the treatment received by their children, they also recommended to extend eligibility to other malnourished children in their neighbourhood. CONCLUSION: In this context, using MUAC as the sole anthropometric criterion for treatment decisions (referral, admission and discharge) resulted in a large number of missed opportunities for children in need of timely and adequate care.

Retroperitoneal Ectopic Pregnancy Presenting as a Massive Retroperitoneal Hematoma.

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Effectiveness of oral sildenafil for neonates with persistent pulmonary hypertension of newborn (PPHN): a prospective study in a tertiary care hospital.

INTRODUCTION: The prevalence of persistent pulmonary hypertension of newborn (PPHN) has been estimated 1.9/1000 live births. Although the efficacy of inhaled nitric oxide and extracorporeal membrane oxygenation in PPHN is well established but it is difficult to administer and monitor in resource limited countries. Owing to this, other treatment options need to be evaluated. METHOD: This is a prospective observational study conducted in the Pediatric Cardiology Department, NICVD, Karachi, from February 2020 to October 2020 after the approval from the Institutional Ethical Review Committee. All the neonates referred to our Unit were screened by echocardiography (echo) and those who fulfilled the inclusion criteria were included. Echo were done before starting sildenafil and after 72 h to assess the pressure gradient across tricuspid valve and right to left or bidirectional shunt across patent ductus arteriosus , patent foramen ovale , or both. Sildenafil was started with a dose of 1 mg/kg/dose thrice a day and increased to 2 mg/kg/dose after 48 h if partial pressure of oxygen (PO1] did not increase. In neonates who did not respond to increased dose of Sildenafil were added on oral Bosentan 1 mg/kg/dose twice a day. RESULTS: Total 82 newborns were enrolled. Fifty-two patients improved after 48 h so were continued on same treatment. Sildenafil dose was increased in 30 (37.9%) patients whose PO2 did not increase to at least 10% from baseline after 48 h of starting treatment. Three patients expired within 48-72 h. Out of 27 remaining patients, only four responded whereas 23 patients did not show any improvement. In these patients, Bosentan was supplemented along with sildenafil. CONCLUSION: The results of our study show effectiveness of oral Sildenafil in treating PPHN. The overall improvement observed in the patients was overwhelming. Combination of Sildenafil with Bosentan is beneficial in patients who did not respond on Sildenafil alone.

Impact of pharmacist-led interventions in improving adherence to glaucoma medications in the geriatric population.

OBJECTIVES: Geriatric patients can be non-adherent to ophthalmic glaucoma medications because of complex eye drops instillation techniques and forgetfulness, so pharmacists can play their part in improving the clinical outcomes of patients by acting as care providers. The purpose of the current study was to implement various pharmacist-led interventions to improve adherence to glaucoma medications and to evaluate the outcomes of interventions in the geriatric population. METHODS: The Morisky Green Levine (MGL) adherence scale was used for analysis because it measures the extent of non-adherence and analyses the reasons for it. The interview-based sessions were conducted with control and interventional groups followed by educational interventions, including techniques for eye drop instillation, graphical images, precautionary measures, and individual patient counselling for the interventional group. Patients were asked to complete the adherence scale after the conclusion of every follow-up session for a duration of 6 months. RESULTS: After 6 months of pharmacist-led interventions, a significant shift was found in the interventional group from low to high adherence according to MGL scale evaluation. Moreover, the number of patients in the interventional group whose intraocular pressure was in the safe range significantly increased and follow-up sessions significantly improved the patient's knowledge about glaucoma. CONCLUSION: The results of this pharmacist-led educational interventional study showed it was effective in improving adherence to glaucoma medications in the geriatric patients, who showed better adherence scores and improved intraocular pressure.

Associative learning in larval and adult Drosophila is impaired by the dopamine-synthesis inhibitor 3-Iodo-L-tyrosine.

Across the animal kingdom, dopamine plays a crucial role in conferring reinforcement signals that teach animals about the causal structure of the world. In the fruit fly Drosophila melanogaster, dopaminergic reinforcement has largely been studied using genetics, whereas pharmacological approaches have received less attention. Here, we apply the dopamine-synthesis inhibitor 3-Iodo-L-tyrosine (3IY), which causes acute systemic inhibition of dopamine signaling, and investigate its effects on Pavlovian conditioning. We find that 3IY feeding impairs sugar-reward learning in larvae while leaving task-relevant behavioral faculties intact, and that additional feeding of a precursor of dopamine (L-3,4-dihydroxyphenylalanine, L-DOPA), rescues this impairment. Concerning a different developmental stage and for the aversive valence domain. Moreover, we demonstrate that punishment learning by activating the dopaminergic neuron PPL1-γ1pedc in adult flies is also impaired by 3IY feeding, and can likewise be rescued by L-DOPA. Our findings exemplify the advantages of using a pharmacological approach in combination with the genetic techniques available in D. melanogaster to manipulate neuronal and behavioral function.

Challenges estimating patient organs doses undergoing enhanced chest CT examination: exploratory study.

Purpose: Estimate organs doses (ODs) of patients subjected to unenhanced (S1) and enhanced (S2) chest CT studies relying on image parameters such as Hounsfield Units (HUs).Materials and Methods: CT scans and images of a total of 16 patients who underwent two series of chest CT studies were obtained and retrospectively examined. OD increments of liver and pancreas for both series (S1 & S2) were estimated using two different independent methods, namely simulation approach using CT-EXPO and Amato's phantom-based fitting model (APFM). HUs were quantified for each organ by manually drawing fixed area-sized regions of interest (ROIs). The mean HUs were collected to obtain the ODs increments following APFM. Regression analysis was applied to find and assess the relationship between the HUs and the OD increments estimated using APFM and that using CT-EXPO. Spearman Coefficient and Wilcoxon Matched Pairedt-testwere conducted to show statistical correlation and difference between ODs increments using the two methods.Results:A strong significant difference was depicted between S1 and S2 scan series of liver and pancreas using CT-EXPO simulation. Mean HU values for S1 were lower than S2, resulting in statistically significant (p < 0.0001) HU changes. CT-EXPO simulation yielded significantly higher difference in ODs compared to the APFM for liver (p = 0.0455) and pancreas (p = 0.0031). Regression analysis revealed a strong relationship between HU of S1 and S2 and ODs increments using APFM in both organs (R2 = 0.99), dissimilar to CT-EXPO (R2 = 0.39 in liver andR2 = 0.05 in pancreas).Conclusions: Although CT-EXPO allows for estimating ODs accounting for major acquisition scan parameters, it is not a reliable tool to evaluate the impact of contrast enhancement on ODs. On the other hand, the APFM accounts for contrast enhancement accumulation yet only provides relative OD increments, an information of limited clinical use.

Prevalence of asthma and its management: A review.

Among respiratory problems, asthma is one of the most apidly growing disorder which has victimised about onethird of the world's population and almost 2.5 million patients die annually as a result of severe exacerbation. Asthmatic patients most of the time fail to receive maximum benefits from the therapy because of drugrelated problems, side effects of steroid medication and special skill required for the administration technique of drug inhalation. The current review was planned to highlight the most frequent problems of asthmatic patients and their possible management suggested during the last few years. The greatest challenge is to ensure adherence to medication along with appropriate inhalation technique among asthmatic Patients Proper selection of drug and Device. According to Global Initiative for Asthma Guidelines 2017, proper counselling, training sessions, dosage calendars, patient reminders and evaluation of inhalation technique are found to be very helpful in improving the quality of life of patients.

Steroid sensitive nephrotic syndrome in paediatrics.

Nephrotic syndrome is basically a set of signs or symptoms that may point to kidney problems, a condition when large amounts of protein leak out into the urine. In children protein excretion greater than 40 mg/m2.hr(-1) indicate presence of nephrotic syndrome. Edema is the prominent feature of nephrotic syndrome and initially develops around the eyes and legs. The 1st line treatment given is steroid therapy. The prospective study was conducted to determine the rational use of steroidal therapy, steroid sensitive nephrotic syndrome and causes of remission. 10 children were selected randomly presenting with the complaint of steroid sensitive nephrotic syndrome. The result of this study provide some evidence that steroidal therapy is effective in treating childhood nephrotic syndrome and they recover more rapidly if the steroidal regimen is carefully followed. It is concluded that rational use of steroid (prednisolone) has a very effective role in the prevention and control of nephrotic syndrome either at initial stage or in complicated cases. Corticosteroids have decreased the mortality rate upto 3%. Some very interesting findings have been observed and thus recorded and reported in this paper.